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Anxiety
& Diving: Anxiety is formally diagnosed under one of the following: Generalized Anxiety Disorder, Panic Disorder & Agoraphobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Social Phobia and Specific Phobia. When speaking of anxiety in the general sense, we typically mean excessive uncontrollable worry about everyday things that has been present more days than not for at least 6 months. This not only is uncomfortable for the sufferer, but it interferes with the performance of tasks and ability to pay attention and concentrate. Affected persons tend to be irritable and complain about feeling on edge, are easily tired and have trouble sleeping. There also may be physical symptoms and signs, including muscle tension, sweating, difficulty swallowing, jumpiness, shaking of the hands, and nausea, gastrointestinal discomfort and diarrhea. Drugs frequently are used to treat significant anxiety. These include selective serotonin reuptake inhibitors (SSRIs) (e.g., Lexapro, Prozac, Zoloft) and benzodiazepines (e.g., Valium, Xanax, Ativan). Like any drug, these have side effects. Common among them ar drowsiness, dizziness and concentration disturbance and deficits in cognition. These are among the reasons that package inserts for most anti-anxiety medicationms contain warnings that the drug may impair the mental and/or physical abilities required for the performance of hazardous tasks, such as operating machinery or driving a car (and scuba?). Tracking and managing variables such as one's depth, location, air supply and buddy status requires a high level of vigilance and sound, smooth decision-making; the requirement for vigorous activity is often just around the corner in the form of a heavy current or buddy in need of rescue; and things don't always go smoothly while diving. Deep underwater is not a benign place to suffer lapses in attention and decisional sharpness, decreased energy level and resistance to fatigue, or anger at minor provocations. Moreover, studies have shown that anxious individuals are more likely to experience diver panic than their more relaxed counterparts. Obviously anti-anxiety medications impact on brain chemistry and it is not unreasonable to suspect the possibly that their activity could be potentiated by the increased partial pressures of gases inherent in scuba and additive with those of nitrogen narcosis. However, this has not been studied. Fortunately, many persons who take drugs for anxiety tolerate them well and what side effects they do experience pass after several weeks of use. Moreover, altering dose size, the times at which doses are taken, and other steps sometimes can manage persistent adverse reactions. Still, it can have enduring, problematic effects in some persons. As such, each individual must carefully monitor how he or she responds to the drug over time before engaging in activities for which side effects could pose a risk. Where does all of this leave the recreational diver being treated for anxiety and the professionals advising him about scuba? One approach to the question, and the one I'd want applied
to myself if ill, is to assume that anxiety and the drugs used to ameliorate
it do not preclude diving provided that: (a) mental status examination
demonstrates the condition to be well controlled; (b) the diver on medication
has been on for an extended period and side effects dangerous to scuba
are neither reported nor observed upon careful examination; (c) there
are no other possible contraindications in the clinical picture; (d) medical
clearance to dive has been obtained; and, (e) the diver feels up to it
and fully comprehends the remaining risks. This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
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